1
|
Genç B, Aslan K, Atay MH, Akan H. Evaluation of microstructural changes in the brain in transfusion dependent thalassemia patients with advanced magnetic resonance imaging techniques. Neuroradiology 2024; 66:1721-1728. [PMID: 38975995 PMCID: PMC11424679 DOI: 10.1007/s00234-024-03414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Transfusion-dependent thalassemia (TDT) is associated with iron accumulation in the body and an increased tendency for thrombosis. With the increased life expectancy in these patients, the detection of neurocognitive complications has gained importance. This study investigates the microstructural changes in TDT patients using advanced diffusion MRI techniques and their relationship with laboratory parameters. METHODS The study included 14 TDT patients and 14 control subjects. Tract-based spatial statistics (TBSS) were used to examine differences in DTI parameters such as fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in thalassemia patients using multi-shell DWI images. The mean kurtosis (MK) difference was investigated using diffusion kurtosis imaging. Fiber density (FD), fiber cross-section (FC), and fiber density and cross-section (FDC) differences were examined using fixel-based analysis. In the patient group, correlative tractography was used to investigate the relationship between DTI parameters and platelet (PLT) and ferritin levels. RESULTS Increase in RD and MD was observed, particularly in the white matter tracts of the corona radiata in patient group. Additionally, an increase in AD was detected in a limited area. Correlative tractography in thalasemia patients showed a positive correlation between increases in RD, MD, and AD with PLT and ferritin. Fixel-based analysis demonstrated a dispersed distribution in white matter fibers, with a more pronounced decrease in FD, FC, and FDC in the internal capsule. CONCLUSION There is widespread involvement in the white matter and fiber tracts in thalassemia patients, which is highly correlated with thrombotic parameters.
Collapse
Affiliation(s)
- Barış Genç
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.
| | - Kerim Aslan
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Memiş Hilmi Atay
- Department of Hematology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Hüseyin Akan
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| |
Collapse
|
2
|
Ramos K, Guilliams KP, Fields ME. The Development of Neuroimaging Biomarkers for Cognitive Decline in Sickle Cell Disease. Hematol Oncol Clin North Am 2022; 36:1167-1186. [PMID: 36400537 PMCID: PMC9973749 DOI: 10.1016/j.hoc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sickle cell disease (SCD) is complicated by neurologic complications including vasculopathy, hemorrhagic or ischemic overt stroke, silent cerebral infarcts and cognitive dysfunction. Patients with SCD, even in the absence of vasculopathy or stroke, have experience cognitive dysfunction that progresses with age. Transcranial Doppler ultrasound and structural brain MRI are currently used for primary and secondary stroke prevention, but laboratory or imaging biomarkers do not currently exist that are specific to the risk of cognitive dysfunction in patients with SCD. Recent investigations have used advanced MR sequences assessing cerebral hemodynamics, white matter microstructure and functional connectivity to better understand the pathophysiology of cognitive decline in SCD, with the long-term goal of developing neuroimaging biomarkers to be used in risk prediction algorithms and to assess the efficacy of treatment options for patients with SCD.
Collapse
Affiliation(s)
- Kristie Ramos
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Neurology, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Melanie E Fields
- Department of Pediatrics, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA; Department of Neurology, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| |
Collapse
|
3
|
González-Zacarías C, Choi S, Vu C, Xu B, Shen J, Joshi AA, Leahy RM, Wood JC. Chronic anemia: The effects on the connectivity of white matter. Front Neurol 2022; 13:894742. [PMID: 35959402 PMCID: PMC9362738 DOI: 10.3389/fneur.2022.894742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/29/2022] [Indexed: 01/26/2023] Open
Abstract
Chronic anemia is commonly observed in patients with hemoglobinopathies, mainly represented by disorders of altered hemoglobin (Hb) structure (sickle cell disease, SCD) and impaired Hb synthesis (e.g. thalassemia syndromes, non-SCD anemia). Both hemoglobinopathies have been associated with white matter (WM) alterations. Novel structural MRI research in our laboratory demonstrated that WM volume was diffusely lower in deep, watershed areas proportional to anemia severity. Furthermore, diffusion tensor imaging analysis has provided evidence that WM microstructure is disrupted proportionally to Hb level and oxygen saturation. SCD patients have been widely studied and demonstrate lower fractional anisotropy (FA) in the corticospinal tract and cerebellum across the internal capsule and corpus callosum. In the present study, we compared 19 SCD and 15 non-SCD anemia patients with a wide range of Hb values allowing the characterization of the effects of chronic anemia in isolation of sickle Hb. We performed a tensor analysis to quantify FA changes in WM connectivity in chronic anemic patients. We calculated the volumetric mean of FA along the pathway of tracks connecting two regions of interest defined by BrainSuite's BCI-DNI atlas. In general, we found lower FA values in anemic patients; indicating the loss of coherence in the main diffusion direction that potentially indicates WM injury. We saw a positive correlation between FA and hemoglobin in these same regions, suggesting that decreased WM microstructural integrity FA is highly driven by chronic hypoxia. The only connection that did not follow this pattern was the connectivity within the left middle-inferior temporal gyrus. Interestingly, more reductions in FA were observed in non-SCD patients (mainly along with intrahemispheric WM bundles and watershed areas) than the SCD patients (mainly interhemispheric).
Collapse
Affiliation(s)
- Clio González-Zacarías
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Chau Vu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Botian Xu
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Jian Shen
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Anand A. Joshi
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States
| | - Richard M. Leahy
- Signal and Image Processing Institute, University of Southern California, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - John C. Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States,Biomedical Engineering, University of Southern California, Los Angeles, CA, United States,*Correspondence: John C. Wood
| |
Collapse
|
4
|
Turner EM, Koskela-Staples MSN, Evans BSC, Black LV, Heaton SC, Fedele DA. The Role of Sleep-Disordered Breathing Symptoms in Neurocognitive Function Among Youth With Sickle Cell Disease1. Dev Neuropsychol 2022; 47:93-104. [PMID: 35157528 DOI: 10.1080/87565641.2022.2038601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine associations between sleep-disordered breathing (SDB) and executive/attentional function in pediatric sickle cell disease (SCD). METHODS Sixty youth with SCD ages 8-18 years and caregivers completed the Pediatric Sleep Questionnaire (PSQ), Delis Kaplan Executive Function System Trail Making Test (DKEFS TMT), Psychomotor Vigilance Test (PVT), and the Behavior Rating Inventory Of Executive Function, Second Edition (BRIEF-2) Parent Report. RESULTS The PSQ significantly predicted the BRIEF-2 Parent Report, F(1, 58) = 44.64, p < .001, R2 = 0.44, f2 = 0.77. CONCLUSIONS Sleep-disordered breathing symptoms may predict informant-rated executive dysfunction in pediatric SCD, but not performance-based executive function.
Collapse
Affiliation(s)
- Elise M Turner
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | | | - B S Corinne Evans
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - L Vandy Black
- Division of Pediatric Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Shelley C Heaton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
5
|
Costa TCDM, Chiari-Correia R, Salmon CEG, Darrigo-Junior LG, Grecco CES, Pieroni F, Faria JTB, Stracieri ABPL, Dias JBE, de Moraes DA, Oliveira MC, Guerino-Cunha R, Santos AC, Simões BP. Hematopoietic stem cell transplantation reverses white matter injury measured by diffusion-tensor imaging (DTI) in sickle cell disease patients. Bone Marrow Transplant 2021; 56:2705-2713. [PMID: 34234298 DOI: 10.1038/s41409-021-01365-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023]
Abstract
Brain injury in sickle cell disease (SCD) comprises a wide spectrum of neurological damage. Neurocognitive deficits have been described even without established neurological lesions. DTI is a rapid, noninvasive, and non-contrast method that enables detection of normal-appearing white matter lesions not detected by conventional magnetic resonance imaging (MRI). The aim of the study was to evaluate if stem cell transplantation can revert white matter lesions in patients with SCD. Twenty-eight SCD patients were evaluated with MRI and DTI before and after allogeneic hematopoietic stem cell transplantation (HSCT), compared with 26 healthy controls (HC). DTI metrics included fractional anisotropy (FA), mean diffusivity (MD), radial (RD), and axial (AD) diffusivity maps, global efficiency, path length, and clustering coefficients. Compared to HC, SCD patients had a lower FA (p = 0.0086) before HSCT. After HSCT, FA increased and was not different from healthy controls (p = 0.1769). Mean MD, RD, and AD decreased after HSCT (p = 0.0049; p = 0.0029; p = 0.0408, respectively). We confirm previous data of white matter lesions in SCD and present evidence that HSCT promotes recovery of brain injury with potential improvement of brain structural connectivity.
Collapse
Affiliation(s)
- Thalita Cristina de Mello Costa
- Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. .,Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
| | - Rodolfo Chiari-Correia
- Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carlos Ernesto G Salmon
- Department of Physics, Faculty of Philosophy, Sciences and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Carlos Eduardo S Grecco
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fabiano Pieroni
- Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Joana Teresa B Faria
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Beatriz P L Stracieri
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana B E Dias
- Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniela Aparecida de Moraes
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Carolina Oliveira
- Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Renato Guerino-Cunha
- Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Antônio Carlos Santos
- Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Belinda P Simões
- Department of Medical Imaging, Hematology and Clinical Oncology, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Center for Cell-Based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
6
|
Issar P, Nehra M, Singh G, Issar SK. Conventional and advanced brain MR imaging in patients with sickle cell anemia. Indian J Radiol Imaging 2021; 28:305-311. [PMID: 30319206 PMCID: PMC6176679 DOI: 10.4103/ijri.ijri_166_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Sickle cell disease (SCD) is an autosomal recessive hemolytic disorder; its cerebrovascular complications include silent cerebral ischemia, infarct, and brain atrophy. Conventional magnetic resonance imaging (MRI) often underestimates the extent of injury. Diffusion tensor imaging (DTI) can demonstrate and quantify microstructural brain changes in SCD cases having normal routine MRI. Objective: To identify various neurological abnormalities in asymptomatic sickle cell patients using routine MRI and to evaluate the microstructure of various regions of the brain using DTI. Materials and Methods: A prospective, randomized case–control study was conducted over a period of 2 years. A total of 58 cases of SCD and 56 age- and sex-matched controls were included. Routine MRI and DTI were performed in both the groups following a standard protocol. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated in certain pre-defined regions. Primary data were analyzed using MS excel version 17. Analysis of variance test was performed and statistical significance was set at P < 0.05. Results: Thirty regions of interest with 60 variables were included in the final analysis. Patients with SCD showed statistically significant reduced FA values, increased ADC values, or both, clustered in several brain areas, including pons, cerebral peduncle, corpus callosum, frontal, temporal, parietal white matter, centrum semiovale, periventricular areas, basal ganglia, and left thalamus (P < 0.05). Conclusion: DTI is a promising method for characterizing microstructural changes, when conventional MRI is normal.
Collapse
Affiliation(s)
- Pratibha Issar
- Department of Radiodiagnosis, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
| | - Maya Nehra
- Department of Radiodiagnosis, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
| | - Gurmeet Singh
- Department of Hematology, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
| | - S K Issar
- Department of Gastroenterology, J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh, India
| |
Collapse
|
7
|
Wang Y, Fellah S, Fields ME, Guilliams KP, Binkley MM, Eldeniz C, Shimony JS, Reis M, Vo KD, Chen Y, Lee JM, An H, Ford AL. Cerebral Oxygen Metabolic Stress, Microstructural Injury, and Infarction in Adults With Sickle Cell Disease. Neurology 2021; 97:e902-e912. [PMID: 34172536 PMCID: PMC8408504 DOI: 10.1212/wnl.0000000000012404] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine the patient- and tissue-based relationships between cerebral hemodynamic and oxygen metabolic stress, microstructural injury, and infarct location in adults with sickle cell disease (SCD). METHODS Control and SCD participants underwent brain MRI to quantify cerebral blood flow (CBF), oxygen extraction fraction (OEF), mean diffusivity (MD), and fractional anisotropy (FA) within normal-appearing white matter (NAWM), and infarcts on FLAIR. Multivariable linear regression examined the patient- and voxel-based associations between hemodynamic and metabolic stress (defined as elevated CBF and OEF, respectively), white matter microstructure, and infarct location. RESULTS Of 83 control and SCD participants, adults with SCD demonstrated increased CBF (50.9 vs 38.8 mL/min/100g, p<0.001), increased OEF (0.35 vs 0.25, p<0.001), increased MD (0.76 vs 0.72 x 10-3mm2 s-1, p=0.005), and decreased FA (0.40 vs 0.42, p=0.021) within NAWM compared to controls. In multivariable analysis, increased OEF (β=0.19, p=0.035), but not CBF (β=0.00, p=0.340), independently predicted increased MD in the SCD cohort, while neither were predictors in controls. On voxel-wise regression, the SCD cohort demonstrated widespread OEF elevation, encompassing deep white matter regions of elevated MD and reduced FA, which spatially extended beyond high density infarct locations from the SCD cohort. CONCLUSION Elevated OEF, a putative index of cerebral oxygen metabolic stress, may provide a metric of ischemic vulnerability which could enable individualization of therapeutic strategies in SCD. The patient- and tissue-based relationships between elevated OEF, elevated MD, and cerebral infarcts suggest that oxygen metabolic stress may underlie microstructural injury prior to the development of cerebral infarcts in SCD.
Collapse
Affiliation(s)
- Yan Wang
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Slim Fellah
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Melanie E Fields
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO
| | - Kristin P Guilliams
- Division of Pediatric Neurology, Washington University School of Medicine, St. Louis, MO
| | - Michael M Binkley
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Martin Reis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Katie D Vo
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Yasheng Chen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Hongyu An
- Department of Neurology, Washington University School of Medicine, St. Louis, MO.,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine, St. Louis, MO; .,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
8
|
Chai Y, Ji C, Coloigner J, Choi S, Balderrama M, Vu C, Tamrazi B, Coates T, Wood JC, O'Neil SH, Lepore N. Tract-specific analysis and neurocognitive functioning in sickle cell patients without history of overt stroke. Brain Behav 2021; 11:e01978. [PMID: 33434353 PMCID: PMC7994688 DOI: 10.1002/brb3.1978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a hereditary blood disorder in which the oxygen-carrying hemoglobin molecule in red blood cells is abnormal. SCD patients are at increased risks for strokes and neurocognitive deficit, even though neurovascular screening and treatments have lowered the rate of overt strokes. Tract-specific analysis (TSA) is a statistical method to evaluate microstructural WM damage in neurodegenerative disorders, using diffusion tensor imaging (DTI). METHODS We utilized TSA and compared 11 major brain WM tracts between SCD patients with no history of overt stroke, anemic controls, and healthy controls. We additionally examined the relationship between the most commonly used DTI metric of WM tracts and neurocognitive performance in the SCD patients and healthy controls. RESULTS Disruption of WM microstructure orientation-dependent metrics for the SCD patients was found in the genu of the corpus callosum (CC), cortico-spinal tract, inferior fronto-occipital fasciculus, right inferior longitudinal fasciculus, superior longitudinal fasciculus, and left uncinate fasciculus. Neurocognitive performance indicated slower processing speed and lower response inhibition skills in SCD patients compared to controls. TSA abnormalities in the CC were significantly associated with measures of processing speed, working memory, and executive functions. CONCLUSION Decreased DTI-derived metrics were observed on six tracts in chronically anemic patients, regardless of anemia subtype, while two tracks with decreased measures were unique to SCD patients. Patients with WMHs had more significant FA abnormalities. Decreased FA values in the CC significantly correlated with all nine neurocognitive tests, suggesting a critical importance for CC in core neurocognitive processes.
Collapse
Affiliation(s)
- Yaqiong Chai
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Chaoran Ji
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Electrical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Julie Coloigner
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Division of CardiologyChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Soyoung Choi
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Melissa Balderrama
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Chau Vu
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Benita Tamrazi
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Thomas Coates
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCAUSA
| | - John C. Wood
- Division of CardiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Sharon H. O'Neil
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
- Division of NeurologyChildren's Hospital Los AngelesLos AngelesCAUSA
- The Saban Research InstituteChildren's Hospital Los AngelesLos AngelesCAUSA
| | - Natasha Lepore
- CIBORG LaboratoryDepartment of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of RadiologyChildren's Hospital Los AngelesLos AngelesCAUSA
- Department of Biomedical EngineeringUniversity of Southern CaliforniaLos AngelesCAUSA
- Department of PediatricsKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| |
Collapse
|
9
|
Jacob M, Stotesbury H, Kawadler JM, Lapadaire W, Saunders DE, Sangeda RZ, Chamba C, Kazema R, Makani J, Kirkham FJ, Clark CA. White Matter Integrity in Tanzanian Children With Sickle Cell Anemia: A Diffusion Tensor Imaging Study. Stroke 2020; 51:1166-1173. [PMID: 32138633 DOI: 10.1161/strokeaha.119.027097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background and Purpose- Widespread reductions in white matter integrity are associated with cognitive dysfunction in sickle cell anemia. Silent cerebral infarction (SCI), vasculopathy (VSC), and low hemoglobin concentration (Hb) are implicated; we aimed to determine independent contributions to microstructural white matter injury and whether white matter integrity differs across arterial territories. Methods- Sixty two children with sickle cell anemia aged 6 to 19 years were prospectively studied at Muhimbili National Hospital, Tanzania. SCI± and VSC± were identified on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) scans by 2 neuroradiologists. Tract-based spatial statistics tested for voxel-wise differences in diffusion tensor imaging metrics (ie, fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity) between SCI± and VSC± groups, with correlations between diffusion tensor imaging metrics and Hb. In tract-based spatial statistics analyses, potentially mediating factors (ie, age, sex, as well as Hb, SCI, and/or vasculopathy) were covariates. Differences in mean diffusion tensor imaging metrics across regions of interest in arterial territories were explored. Results- Compared with SCI- patients (n=45), SCI+ patients (n=17) exhibited increased radial diffusivity in multiple regions; negative relationships were observed between mean diffusivity, axial diffusivity, and Hb (P<0.005). Compared with VSC- patients (n=49), mild (n=6) or moderate (n=7) VSC+ patients exhibited reduced fractional anisotropy in widespread regions (P<0.05) including the anterior longitudinal fasciculi, corpus callosum, internal capsule, corona radiata, and corticospinal tracts. Overall, the posterior cerebral arterial territory had higher mean mean diffusivity and mean radial diffusivity than the anterior and middle cerebral arterial territories, although no patient had vasculopathy in this area. There was an interaction between territory and vasculopathy. Conclusions- SCI, vasculopathy, and Hb are independent risk factors, and thus treatment targets, for diffuse white matter injury in patients with sickle cell anemia. Exacerbation of hemodynamic stress may play a role.
Collapse
Affiliation(s)
- Mboka Jacob
- From the Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania (M.J., R.K.).,Muhimbili Sickle Cell Program (M.J., R.Z.S., J.M.), Muhimbili University of Health and Allied Sciences
| | - Hanne Stotesbury
- Developmental Neurosciences Section (H.S., J.M.K., W.L., D.E.S., F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences Section (H.S., J.M.K., W.L., D.E.S., F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom
| | - Winok Lapadaire
- Developmental Neurosciences Section (H.S., J.M.K., W.L., D.E.S., F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences Section (H.S., J.M.K., W.L., D.E.S., F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom
| | - Raphael Z Sangeda
- Muhimbili Sickle Cell Program (M.J., R.Z.S., J.M.), Muhimbili University of Health and Allied Sciences.,Department of Pharmaceutical Microbiology (R.Z.S.), Muhimbili University of Health and Allied Sciences
| | - Clara Chamba
- Department of Haematology and Blood Transfusion (C.C., J.M.), Muhimbili University of Health and Allied Sciences
| | - Ramadhan Kazema
- From the Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania (M.J., R.K.)
| | - Julie Makani
- Muhimbili Sickle Cell Program (M.J., R.Z.S., J.M.), Muhimbili University of Health and Allied Sciences.,Department of Haematology and Blood Transfusion (C.C., J.M.), Muhimbili University of Health and Allied Sciences
| | - Fenella J Kirkham
- Developmental Neurosciences Section (H.S., J.M.K., W.L., D.E.S., F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Unit (F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom.,Clinical Experimental Sciences, University of Southampton, University Hospital Southampton NHS Foundation Trust, United Kingdom (F.J.K.).,King's College Hospital, London, United Kingdom (F.J.K.)
| | - Chris A Clark
- Developmental Neurosciences Section (H.S., J.M.K., W.L., D.E.S., F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Unit (F.J.K., C.A.C.), UCL Great Ormond Street Hospital for Children, London, United Kingdom
| |
Collapse
|
10
|
Lance EI, Jordan LC. Hydroxycarbamide and white matter integrity in paediatric sickle cell disease. Br J Haematol 2019. [DOI: 10.1111/bjh.16237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eboni I. Lance
- Department of Neurodevelopmental Medicine Kennedy Krieger Institute Baltimore MD USA
- Department of Neurology The Johns Hopkins University School of Medicine Baltimore MD USA
| | - Lori C. Jordan
- Department of Pediatrics Division of Pediatric Neurology Vanderbilt University Medical Center Nashville TN USA
| |
Collapse
|
11
|
Choi S, O'Neil SH, Joshi AA, Li J, Bush AM, Coates TD, Leahy RM, Wood JC. Anemia predicts lower white matter volume and cognitive performance in sickle and non-sickle cell anemia syndrome. Am J Hematol 2019; 94:1055-1065. [PMID: 31259431 DOI: 10.1002/ajh.25570] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022]
Abstract
Severe chronic anemia is an independent predictor of overt stroke, white matter damage, and cognitive dysfunction in the elderly. Severe anemia also predisposes to white matter strokes in young children, independent of the anemia subtype. We previously demonstrated symmetrically decreased white matter (WM) volumes in patients with sickle cell disease (SCD). In the current study, we investigated whether patients with non-sickle anemia also have lower WM volumes and cognitive dysfunction. Magnetic Resonance Imaging was performed on 52 clinically asymptomatic SCD patients (age = 21.4 ± 7.7; F = 27, M = 25; hemoglobin = 9.6 ± 1.6 g/dL), 26 non-sickle anemic patients (age = 23.9 ± 7.9; F = 14, M = 12; hemoglobin = 10.8 ± 2.5 g/dL) and 40 control subjects (age = 27.7 ± 11.3; F = 28, M = 12; hemoglobin = 13.4 ± 1.3 g/dL). Voxel-wise changes in WM brain volumes were compared to hemoglobin levels to identify brain regions that are vulnerable to anemia. White matter volume was diffusely lower in deep, watershed areas proportionally to anemia severity. After controlling for age, sex, and hemoglobin level, brain volumes were independent of disease. WM volume loss was associated with lower Full Scale Intelligence Quotient (FSIQ; P = .0048; r2 = .18) and an abnormal burden of silent cerebral infarctions (P = .029) in males, but not in females. Hemoglobin count and cognitive measures were similar between subjects with and without white-matter hyperintensities. The spatial distribution of volume loss suggests chronic hypoxic cerebrovascular injury, despite compensatory hyperemia. Neurocognitive consequences of WM volume changes and silent cerebral infarction were strongly sexually dimorphic. Understanding the possible neurological consequences of chronic anemia may help inform our current clinical practices.
Collapse
Affiliation(s)
- Soyoung Choi
- Neuroscience Graduate ProgramUniversity of Southern California Los Angeles California
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
| | - Sharon H. O'Neil
- The Saban Research Institute, Children's Hospital Los Angeles Los Angeles California
- Division of NeurologyChildren's Hospital Los Angeles Los Angeles California
- Department of Pediatrics, Keck School of MedicineUniversity of Southern California Los Angeles California
| | - Anand A. Joshi
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
| | - Jian Li
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
| | - Adam M. Bush
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
- Biomedical EngineeringUniversity of Southern California Los Angeles California
- Radiology DepartmentStanford University Stanford California
| | - Thomas D. Coates
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
- Department of Pediatrics, Keck School of MedicineUniversity of Southern California Los Angeles California
| | - Richard M. Leahy
- Neuroscience Graduate ProgramUniversity of Southern California Los Angeles California
- Signal and Image Processing InstituteUniversity of Southern California Los Angeles California
| | - John C. Wood
- Division of Hematology, Oncology and Blood and Marrow TransplantationChildren's Hospital Los Angeles Los Angeles California
- Department of Pediatrics, Keck School of MedicineUniversity of Southern California Los Angeles California
| |
Collapse
|
12
|
Lance EI, Jordan LC. Hydroxycarbamide and white matter integrity in pediatric sickle cell disease: Commentary to accompany: Hydroxycarbamide treatment in children with sickle cell anaemia is associated with more intact white matter integrity: a quantitative MRI study. Br J Haematol 2019; 187:141-143. [PMID: 31598967 PMCID: PMC6800718 DOI: 10.1111/bjh.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eboni I. Lance
- Department of Neurodevelopmental Medicine, Kennedy Krieger
Institute, Baltimore, MD
- Department of Neurology, The Johns Hopkins University
School of Medicine, Baltimore, MD
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology,
Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
13
|
Stotesbury H, Kawadler JM, Hales PW, Saunders DE, Clark CA, Kirkham FJ. Vascular Instability and Neurological Morbidity in Sickle Cell Disease: An Integrative Framework. Front Neurol 2019; 10:871. [PMID: 31474929 PMCID: PMC6705232 DOI: 10.3389/fneur.2019.00871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
It is well-established that patients with sickle cell disease (SCD) are at substantial risk of neurological complications, including overt and silent stroke, microstructural injury, and cognitive difficulties. Yet the underlying mechanisms remain poorly understood, partly because findings have largely been considered in isolation. Here, we review mechanistic pathways for which there is accumulating evidence and propose an integrative systems-biology framework for understanding neurological risk. Drawing upon work from other vascular beds in SCD, as well as the wider stroke literature, we propose that macro-circulatory hyper-perfusion, regions of relative micro-circulatory hypo-perfusion, and an exhaustion of cerebral reserve mechanisms, together lead to a state of cerebral vascular instability. We suggest that in this state, tissue oxygen supply is fragile and easily perturbed by changes in clinical condition, with the potential for stroke and/or microstructural injury if metabolic demand exceeds tissue oxygenation. This framework brings together recent developments in the field, highlights outstanding questions, and offers a first step toward a linking pathophysiological explanation of neurological risk that may help inform future screening and treatment strategies.
Collapse
Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Department of Radiology, Great Ormond Hospital, London, United Kingdom
| | - Christopher A Clark
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Child Health, University Hospital Southampton, Southampton, United Kingdom.,Department of Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
14
|
Kapustin D, Leung J, Odame I, Williams S, Shroff M, Kassner A. Hydroxycarbamide treatment in children with Sickle Cell Anaemia is associated with more intact white matter integrity: a quantitative MRI study. Br J Haematol 2019; 187:238-245. [PMID: 31215028 DOI: 10.1111/bjh.16063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022]
Abstract
Sickle cell anaemia (SCA) is a devastating genetic blood disorder leading to chronic anaemia, impaired cerebrovascular dilatory capacity and cerebral infarctions. Our aim was to assess the relationship between microstructural properties of the white matter (WM) and both cerebrovascular reactivity (CVR) and cerebral blood flow, as well as the effects of hydroxycarbamide on these relationships. Our results demonstrate that mean CVR was increased in hydroxycarbamide-treated patients compared to untreated patients. Moreover, untreated SCA patients had increased skew and kurtosis of mean diffusivity histograms in the WM compared to hydroxycarbamide-treated patients and healthy age-matched controls, indicating disruption of WM integrity. Regression analysis of CVR and WM mean diffusivity (MD) revealed a significant linear relationship between CVR and MD histogram skew and kurtosis in healthy controls, but not in either of the two SCA groups. These findings suggest that patients treated with hydroxycarbamide possess white matter MD histogram parameters which more closely resemble those of healthy controls.
Collapse
Affiliation(s)
- Daniel Kapustin
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jackie Leung
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Isaac Odame
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suzan Williams
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Kassner
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Li X, Weissman M, Talati A, Svob C, Wickramaratne P, Posner J, Xu D. A diffusion tensor imaging study of brain microstructural changes related to religion and spirituality in families at high risk for depression. Brain Behav 2019; 9:e01209. [PMID: 30648349 PMCID: PMC6379589 DOI: 10.1002/brb3.1209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Previously in a three-generation study of families at high risk for depression, we found that belief in the importance of religion/spirituality (R/S) was associated with thicker cortex in bilateral parietal and occipital regions. In the same sample using functional magnetic resonance imaging and electroencephalograph (EEG), we found that offspring at high familial risk had thinner cortices, increased default mode network connectivity, and reduced EEG power. These group differences were significantly diminished in offspring at high risk who reported high importance of R/S beliefs, suggesting a protective effect. METHODS This study extends previous work examining brain microstructural differences associated with risk for major depressive disorder (MDD) and tests whether these are normalized in at-risk offspring who report high importance of R/S beliefs. Diffusion tensor imaging (DTI) data were selected from 99 2nd and 3rd generation offspring of 1st generation depressed (high-risk, HR) or nondepressed (low-risk, LR) parents. Whole-brain and region-of-interest analyses were performed, using ellipsoidal area ratio (EAR, an alternative diffusion anisotropy index comparable to fractional anisotropy). We examined microstructural differences associated with familial risk for depression within the groups of high and low importance of R/S beliefs (HI, LI). RESULTS In the LI group, HR individuals showed significantly decreased EAR in white matter regions neighboring the precuneus, superior parietal lobe, superior and middle frontal gyrus, and bilateral insula, supplementary motor area, and postcentral gyrus. In the HI group, HR individuals showed reduced EAR in white matter surrounding the left superior, and middle frontal gyrus, left superior parietal lobule, and right supplementary motor area. Microstructural differences associated with familial risk for depression in precuneus, frontal lobe, and temporal lobe were nonsignificant or less significant in the HI group. CONCLUSION R/S beliefs may affect microstructure in brain regions associated with R/S, potentially conferring resilience to depression among HR individuals.
Collapse
Affiliation(s)
- Xuzhou Li
- East China Normal University, Shanghai, China.,Department of Psychiatry, Columbia University, New York, New York.,New York State Psychiatry Institute, New York, New York
| | - Myrna Weissman
- Department of Psychiatry, Columbia University, New York, New York.,New York State Psychiatry Institute, New York, New York
| | - Ardesheer Talati
- Department of Psychiatry, Columbia University, New York, New York.,New York State Psychiatry Institute, New York, New York
| | - Connie Svob
- Department of Psychiatry, Columbia University, New York, New York.,New York State Psychiatry Institute, New York, New York
| | - Priya Wickramaratne
- Department of Psychiatry, Columbia University, New York, New York.,New York State Psychiatry Institute, New York, New York
| | - Jonathan Posner
- Department of Psychiatry, Columbia University, New York, New York.,New York State Psychiatry Institute, New York, New York
| | - Dongrong Xu
- Department of Psychiatry, Columbia University, New York, New York.,New York State Psychiatry Institute, New York, New York
| |
Collapse
|
16
|
Stotesbury H, Kirkham FJ, Kölbel M, Balfour P, Clayden JD, Sahota S, Sakaria S, Saunders DE, Howard J, Kesse-Adu R, Inusa B, Pelidis M, Chakravorty S, Rees DC, Awogbade M, Wilkey O, Layton M, Clark CA, Kawadler JM. White matter integrity and processing speed in sickle cell anemia. Neurology 2018; 90:e2042-e2050. [PMID: 29752305 PMCID: PMC5993179 DOI: 10.1212/wnl.0000000000005644] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/14/2018] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this retrospective cross-sectional study was to investigate whether changes in white matter integrity are related to slower processing speed in sickle cell anemia. Methods Thirty-seven patients with silent cerebral infarction, 46 patients with normal MRI, and 32 sibling controls (age range 8–37 years) underwent cognitive assessment using the Wechsler scales and 3-tesla MRI. Tract-based spatial statistics analyses of diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) parameters were performed. Results Processing speed index (PSI) was lower in patients than controls by 9.34 points (95% confidence interval: 4.635–14.855, p = 0.0003). Full Scale IQ was lower by 4.14 scaled points (95% confidence interval: −1.066 to 9.551, p = 0.1), but this difference was abolished when PSI was included as a covariate (p = 0.18). There were no differences in cognition between patients with and without silent cerebral infarction, and both groups had lower PSI than controls (both p < 0.001). In patients, arterial oxygen content, socioeconomic status, age, and male sex were identified as predictors of PSI, and correlations were found between PSI and DTI scalars (fractional anisotropy r = 0.614, p < 0.00001; r = −0.457, p < 0.00001; mean diffusivity r = −0.341, p = 0.0016; radial diffusivity r = −0.457, p < 0.00001) and NODDI parameters (intracellular volume fraction r = 0.364, p = 0.0007) in widespread regions. Conclusion Our results extend previous reports of impairment that is independent of presence of infarction and may worsen with age. We identify processing speed as a vulnerable domain, with deficits potentially mediating difficulties across other domains, and provide evidence that reduced processing speed is related to the integrity of normal-appearing white matter using microstructure parameters from DTI and NODDI.
Collapse
Affiliation(s)
- Hanne Stotesbury
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Fenella J Kirkham
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK.
| | - Melanie Kölbel
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Philippa Balfour
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jonathan D Clayden
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sati Sahota
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Simrat Sakaria
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Dawn E Saunders
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jo Howard
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rachel Kesse-Adu
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Baba Inusa
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Maria Pelidis
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Subarna Chakravorty
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - David C Rees
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Moji Awogbade
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Olu Wilkey
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Mark Layton
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Christopher A Clark
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jamie M Kawadler
- From Developmental Neurosciences (H.S., F.J.K., M.K., P.B., J.D.C., S. Sahota, S. Sakaria, C.A.C., J.M.K.), UCL Great Ormond Street Institute of Child Health, London; University Hospital Southampton NHS Foundation Trust (F.J.K.); Clinical and Experimental Sciences (F.J.K.), University of Southampton; Department of Radiology (D.E.S.), Great Ormond Street Hospital NHS Foundation Trust, London; Department of Haematology and Evelina Children's Hospital (J.H., R.K.-A., B.I., M.P.), Guy's and St Thomas' NHS Foundation Trust, London; King's College Hospital NHS Foundation Trust (S.C., D.C.R., M.A.), London; North Middlesex University Hospital NHS Foundation Trust (O.W.), London; and Department of Haematology (M.L.), Imperial College Healthcare NHS Foundation Trust, London, UK
| |
Collapse
|
17
|
Fields ME, Guilliams KP, Ragan DK, Binkley MM, Eldeniz C, Chen Y, Hulbert ML, McKinstry RC, Shimony JS, Vo KD, Doctor A, An H, Ford AL, Lee JM. Regional oxygen extraction predicts border zone vulnerability to stroke in sickle cell disease. Neurology 2018; 90:e1134-e1142. [PMID: 29500287 PMCID: PMC5880632 DOI: 10.1212/wnl.0000000000005194] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/05/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine mechanisms underlying regional vulnerability to infarction in sickle cell disease (SCD) by measuring voxel-wise cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen utilization (CMRO2) in children with SCD. METHODS Participants underwent brain MRIs to measure voxel-based CBF, OEF, and CMRO2. An infarct heat map was created from an independent pediatric SCD cohort with silent infarcts and compared to prospectively obtained OEF maps. RESULTS Fifty-six participants, 36 children with SCD and 20 controls, completed the study evaluation. Whole-brain CBF (99.2 vs 66.3 mL/100 g/min, p < 0.001), OEF (42.7% vs 28.8%, p < 0.001), and CMRO2 (3.7 vs 2.5 mL/100 g/min, p < 0.001) were higher in the SCD cohort compared to controls. A region of peak OEF was identified in the deep white matter in the SCD cohort, delineated by a ratio map of average SCD to control OEF voxels. CMRO2 in this region, which encompassed the CBF nadir, was low relative to all white matter (p < 0.001). Furthermore, this peak OEF region colocalized with regions of greatest infarct density derived from an independent SCD cohort. CONCLUSIONS Elevated OEF in the deep white matter identifies a signature of metabolically stressed brain tissue at increased stroke risk in pediatric patients with SCD. We propose that border zone physiology, exacerbated by chronic anemic hypoxia, explains the high risk in this region.
Collapse
Affiliation(s)
- Melanie E Fields
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Kristin P Guilliams
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Dustin K Ragan
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Michael M Binkley
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Cihat Eldeniz
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Yasheng Chen
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Monica L Hulbert
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Robert C McKinstry
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Joshua S Shimony
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Katie D Vo
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Allan Doctor
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Hongyu An
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Andria L Ford
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO
| | - Jin-Moo Lee
- From the Division of Pediatric Hematology/Oncology (M.E.F., M.L.H.), Division of Pediatric Neurology (K.P.G.), Division of Pediatric Critical Care Medicine (K.P.G., A.D.), Department of Neurology (D.K.R., Y.C., A.L.F., J.-M.L.), and Mallinckrodt Institute of Radiology (C.E., R.C.M., J.S.S., K.D.V., H.A., J.-M.L.), Washington University School of Medicine; and Department of Biomedical Engineering (M.B.M., J.-M.L.), Washington University, St. Louis, MO.
| |
Collapse
|
18
|
Pavlakis SG, Roach ES. Silent cerebral infarction: Not so silent after all. Neurology 2018; 90:105-106. [PMID: 29263219 DOI: 10.1212/wnl.0000000000004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Steven G Pavlakis
- From the Icahn School of Medicine at Mount Sinai (S.G.P.), New York, NY; and Ohio State University (E.S.R.), Columbus.
| | - E Steve Roach
- From the Icahn School of Medicine at Mount Sinai (S.G.P.), New York, NY; and Ohio State University (E.S.R.), Columbus
| |
Collapse
|
19
|
Coloigner J, Phlypo R, Coates TD, Lepore N, Wood JC. Graph Lasso-Based Test for Evaluating Functional Brain Connectivity in Sickle Cell Disease. Brain Connect 2017; 7:443-453. [PMID: 28747064 PMCID: PMC5647492 DOI: 10.1089/brain.2016.0474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Sickle cell disease (SCD) is a vascular disorder that is often associated with recurrent ischemia-reperfusion injury, anemia, vasculopathy, and strokes. These cerebral injuries are associated with neurological dysfunction, limiting the full developing potential of the patient. However, recent large studies of SCD have demonstrated that cognitive impairment occurs even in the absence of brain abnormalities on conventional magnetic resonance imaging (MRI). These observations support an emerging consensus that brain injury in SCD is diffuse and that conventional neuroimaging often underestimates the extent of injury. In this article, we postulated that alterations in the cerebral connectivity may constitute a sensitive biomarker of SCD severity. Using functional MRI, a connectivity study analyzing the SCD patients individually was performed. First, a robust learning scheme based on graphical lasso model and Fréchet mean was used for estimating a consistent descriptor of healthy brain connectivity. Then, we tested a statistical method that provides an individual index of similarity between this healthy connectivity model and each SCD patient's connectivity matrix. Our results demonstrated that the reference connectivity model was not appropriate to model connectivity for only 4 out of 27 patients. After controlling for the gender, two separate predictors of this individual similarity index were the anemia (p = 0.02) and white matter hyperintensities (WMH) (silent stroke) (p = 0.03), so that patients with low hemoglobin level or with WMH have the least similarity to the reference connectivity model. Further studies are required to determine whether the resting-state connectivity changes reflect pathological changes or compensatory responses to chronic anemia.
Collapse
Affiliation(s)
- Julie Coloigner
- CIBORG, Division of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Ronald Phlypo
- University of Grenoble Alpes, CNRS, Grenoble INP, GIPSA-Lab, Grenoble, France
| | - Thomas D. Coates
- Division of Hematology, Children's Hospital Los Angeles, Los Angeles, California
| | - Natasha Lepore
- CIBORG, Division of Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - John C. Wood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California
| |
Collapse
|
20
|
Sun B, Brown RC, Burns TG, Murdaugh D, Palasis S, Jones RA. Differences in Activation and Deactivation in Children with Sickle Cell Disease Compared with Demographically Matched Controls. AJNR Am J Neuroradiol 2017; 38:1242-1247. [PMID: 28408626 DOI: 10.3174/ajnr.a5170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Declines in both functional activation and functional connectivity have been reported in patients with sickle cell disease. In this study, we derived the functional and default mode responses to a word stem paradigm in age-, ethnicity-, and background-matched subjects with sickle cell disease and control groups, with the aim of testing whether both networks were similarly attenuated and whether the changes were related to physiologic parameters that characterize sickle cell disease. MATERIALS AND METHODS Both the functional and default mode responses were obtained from age- and background-matched controls and the sickle cell population by using a visually presented word stem paradigm on a 3T scanner. RESULTS We observed an attenuated response to both activation and deactivation in the sickle cell disease group. There were no significant differences in the activation response between the 2 groups for the contrast control > sickle cell disease; however, significant differences were observed in the medial parietal cortex, the auditory cortex, and the angular gyrus for the default mode. For the sickle cell group, a significant correlation between the activation z scores and the physiologic parameters was observed; for the deactivation, the results were not significant but the trend was similar. CONCLUSIONS The results indicate that the physiologic parameters modulate the activation in the expected fashion, but that the effect was weaker for deactivation. Given that significant differences between the 2 groups were only seen for deactivation, additional factors must modulate the deactivation in sickle cell disease.
Collapse
Affiliation(s)
- B Sun
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | | | - T G Burns
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - D Murdaugh
- Neuropsychology (T.G.B., D.M.), Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S Palasis
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| | - R A Jones
- From the Departments of Radiology (B.S., S.P., R.A.J.)
| |
Collapse
|
21
|
Cui MH, Suzuka SM, Branch NA, Ambadipudi K, Thangaswamy S, Acharya SA, Billett HH, Branch CA. Brain neurochemical and hemodynamic findings in the NY1DD mouse model of mild sickle cell disease. NMR IN BIOMEDICINE 2017; 30:e3692. [PMID: 28186661 DOI: 10.1002/nbm.3692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 11/10/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
To characterize the cerebral profile associated with sickle cell disease (SCD), we used in vivo proton MRI and MRS to quantify hemodynamics and neurochemicals in the thalamus of NY1DD mice, a mild model of SCD, and compared them with wild-type (WT) control mice. Compared with WT mice, NY1DD mice at steady state had elevated cerebral blood flow (CBF) and concentrations of N-acetylaspartate (NAA), glutamate (Glu), alanine, total creatine and N-acetylaspartylglutamate. Concentrations of glutathione (GSH) at steady state showed a negative correlation with BOLD signal change in response to 100% oxygen, a marker for oxidative stress, and mean diffusivity assessed using diffusion-tensor imaging, a marker for edematous inflammation. In NY1DD mice, elevated basal CBF was correlated negatively with [NAA], but positively with concentration of glutamine ([Gln]). Immediately after experimental hypoxia (at reoxygenation after 18 hours of 8% O2 ), concentrations of NAA, Glu, GSH, Gln and taurine (Tau) increased only in NY1DD mice. [NAA], [Glu], [GSH] and [Tau] all returned to baseline levels two weeks after the hypoxic episode. The altered neurochemical profile in the NY1DD mouse model of SCD at steady state and following experimental hypoxia/reoxygenation suggests a state of chronic oxidative stress leading to compensatory cerebral metabolic adjustments.
Collapse
Affiliation(s)
- Min-Hui Cui
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Radiology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sandra M Suzuka
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicholas A Branch
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Aerospace Engineering, Georgia Tech, Atlanta, GA, USA
| | - Kamalakar Ambadipudi
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sangeetha Thangaswamy
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Seetharama A Acharya
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine (Hematology), Albert Einstein College of Medicine, Bronx, New York, USA
| | - Henny H Billett
- Department of Medicine (Hematology), Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Craig A Branch
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Radiology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
22
|
Choi S, Bush AM, Borzage MT, Joshi AA, Mack WJ, Coates TD, Leahy RM, Wood JC. Hemoglobin and mean platelet volume predicts diffuse T1-MRI white matter volume decrease in sickle cell disease patients. NEUROIMAGE-CLINICAL 2017; 15:239-246. [PMID: 28540180 PMCID: PMC5430155 DOI: 10.1016/j.nicl.2017.04.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/13/2017] [Accepted: 04/25/2017] [Indexed: 02/01/2023]
Abstract
Sickle cell disease (SCD) is a life-threatening genetic condition. Patients suffer from chronic systemic and cerebral vascular disease that leads to early and cumulative neurological damage. Few studies have quantified the effects of this disease on brain morphometry and even fewer efforts have been devoted to older patients despite the progressive nature of the disease. This study quantifies global and regional brain volumes in adolescent and young adult patients with SCD and racially matched controls with the aim of distinguishing between age related changes associated with normal brain maturation and damage from sickle cell disease. T1 weighted images were acquired on 33 clinically asymptomatic SCD patients (age = 21.3 ± 7.8; F = 18, M = 15) and 32 racially matched control subjects (age = 24.4 ± 7.5; F = 22, M = 10). Exclusion criteria included pregnancy, previous overt stroke, acute chest, or pain crisis hospitalization within one month. All brain volume comparisons were corrected for age and sex. Globally, grey matter volume was not different but white matter volume was 8.1% lower (p = 0.0056) in the right hemisphere and 6.8% (p = 0.0068) in the left hemisphere in SCD patients compared with controls. Multivariate analysis retained hemoglobin (β = 0.33; p = 0.0036), sex (β = 0.35; p = 0.0017) and mean platelet volume (β = 0.27; p = 0.016) as significant factors in the final prediction model for white matter volume for a combined r2 of 0.37 (p < 0.0001). Lower white matter volume was confined to phylogenetically younger brain regions in the anterior and middle cerebral artery distributions. Our findings suggest that there are diffuse white matter abnormalities in SCD patients, especially in the frontal, parietal and temporal lobes, that are associated with low hemoglobin levels and mean platelet volume. The pattern of brain loss suggests chronic microvascular insufficiency and tissue hypoxia as the causal mechanism. However, longitudinal studies of global and regional brain morphometry can help us give further insights on the pathophysiology of SCD in the brain. Total white matter brain volume is decreased in sickle cell disease patients. Global white matter decrease is found to be due to anemia. Diffuse WM volume decrease is found especially in watershed areas. Diffuse WM volume decrease spatially colocalize with silent stroke in SCD patients.
Collapse
Key Words
- ACA, anterior cerebral artery
- GM, grey matter
- Hemoglobin
- HgB, hemoglobin
- MCA, middle cerebral artery
- MPV, mean platelet volume
- MRI, magnetic resonance imaging
- Mean platelet volume
- PCA, posterior cerebral artery
- ROI, region of interest
- SCD, sickle cell disease
- Sickle cell disease
- Structural MRI
- WM, white matter
- WMHI, white matter hyperintensities
- White matter
Collapse
Affiliation(s)
- Soyoung Choi
- Neuroscience Graduate Program, University of Southern California, 3641 Watt Way, HNB 120, Los Angeles, CA 90089-2520, USA; Signal and Image Processing Institution, University of Southern California, 3740 McClintock Avenue, EEB 400, Los Angeles, CA 90089-2560, USA; Department of Pediatrics and Radiology, Children's Hospital Los Angeles USC, 4650 Sunset Blvd., MS #81, Los Angeles, CA 90027, USA.
| | - Adam M Bush
- Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA.
| | - Matthew T Borzage
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles USC, 4650 Sunset Blvd., MS #81, Los Angeles, CA 90027, USA.
| | - Anand A Joshi
- Signal and Image Processing Institution, University of Southern California, 3740 McClintock Avenue, EEB 400, Los Angeles, CA 90089-2560, USA.
| | - William J Mack
- Department of Neurosurgery, University of Southern California Keck School of Medicine, 1200 North State St., Suite 3300, Los Angeles, CA 90033, USA.
| | - Thomas D Coates
- Hematology/Oncology, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #54, Los Angeles, CA 90027, USA.
| | - Richard M Leahy
- Signal and Image Processing Institution, University of Southern California, 3740 McClintock Avenue, EEB 400, Los Angeles, CA 90089-2560, USA; Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA.
| | - John C Wood
- Department of Pediatrics and Radiology, Children's Hospital Los Angeles USC, 4650 Sunset Blvd., MS #81, Los Angeles, CA 90027, USA; Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA.
| |
Collapse
|
23
|
Enhanced Long-Term Brain Magnetic Resonance Imaging Evaluation of Children with Sickle Cell Disease after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:670-676. [PMID: 28089760 DOI: 10.1016/j.bbmt.2017.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/03/2017] [Indexed: 11/23/2022]
Abstract
Progressive neurovasculopathy in children with sickle cell disease (SCD) results in decreased cognitive function and quality of life (QoL). Hematopoietic cell transplantation (HCT) is believed to halt progression of neurovasculopathy. Quantitative analysis of T2-weighted fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) for white matter hyperintensity (WMH) burden provides a meaningful estimate of small vessel cerebrovascular disease. We asked if quantitative analysis of WMH could complement standardized clinical assessment of MRI/magnetic resonance angiography (MRA) for assessing SCD central nervous system vasculopathy before and after HCT. Retrospective longitudinal clinical examination of scheduled annual MRI/MRA and quantitative analysis of WMH were performed before and 1 to 7 years after HCT at scheduled annual intervals, along with QoL measurements, in children who had engrafted after HCT. Of 18 patients alive and persistently engrafted (median age, 9.1 years), pretransplantation MRI demonstrated that 9 and 5 had sickle-related stroke and/or small infarcts, respectively. Patients were divided into WMH severity tertiles based on pretransplantation WMH volumes. MRI and WMH were assessed 1 to 7 years after HCT. MRI/MRA and WMH volume were stable or slightly better in 17 of 18 patients. By parent- and self-report, post-HCT QoL improved for children in the lowest WMH tertile significantly more than in the other groups. Based on this single-institution retrospective sample, we report that WMH appears to quantitatively support MRI-based findings that HCT stabilizes long-term small and large vessel cerebrovascular changes and is associated with the degree of improved QoL. While confirmation in larger prospective studies and evaluation by neurocognitive testing are needed, these findings suggest that WMH is a useful biomarker of neurovasculopathy after transplantation for SCD.
Collapse
|
24
|
Chai Y, Lao Y, Li Y, Ji C, O'Neil S, Wang Y, Lepore N, Wood J. Multivariate surface-based analysis of corpus callosum in patients with sickle cell disease. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 10160:101600A. [PMID: 31178616 PMCID: PMC6554202 DOI: 10.1117/12.2257399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sickle cell disease (SCD) is a genetic hematological disease in which the hemoglobin molecule in red blood cells is abnormal. It is closely associated with many symptoms, including pain, anemia, chest syndrome and neurocognitive impairment. One of the most debilitating symptoms is elevated risk for cerebro-vascular accidents. The corpus callosum (CC), as the largest and most prominent white matter (WM) structure in the brain, can reflect the chronic cerebrovascular damage resulting from silent strokes or infarctions in asymptomatic SCD patients. While a lot of studies have reported WM alterations in this cohort, little is known about the shape deformation of the CC. Here we perform the first surface morphometry analysis of the CC in SCD patients using four different shape metrics on T1-weighted magnetic resonance images. We detect regional surface morphological differences in the CC between 11 patients and 10 healthy control subjects. Differences are located in the genu, posterior midbody and splenium, potentially casting light on the anatomical substrates underlying neuropsychological test differences between the SCD and control groups.
Collapse
Affiliation(s)
- Yaqiong Chai
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA
- Department of Radiology, University of Southern California, CA, USA
- Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Yi Lao
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA
- Department of Radiology, University of Southern California, CA, USA
- Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Yicen Li
- Department of Electrical Engineering, University of Southern California, CA, USA
| | - Chaoran Ji
- Department of Electrical Engineering, University of Southern California, CA, USA
| | - Sharon O'Neil
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA
- Department of Radiology, University of Southern California, CA, USA
- Department of Biomedical Engineering, University of Southern California, CA, USA
- Department of Electrical Engineering, University of Southern California, CA, USA
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| | - Yalin Wang
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Natasha Lepore
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA
- Department of Radiology, University of Southern California, CA, USA
- Department of Biomedical Engineering, University of Southern California, CA, USA
| | - John Wood
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| |
Collapse
|
25
|
Chai Y, Coloigner J, Qu X, Choi S, Bush A, Borzage M, Vu C, Lepore N, Wood J. Tract specific analysis in patients with sickle cell disease. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9681. [PMID: 30344363 DOI: 10.1117/12.2213617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sickle cell disease (SCD) is a hereditary blood disorder in which the oxygen-carrying hemoglobin molecule in red blood cells is abnormal. It affects numerous people in the world and leads to a shorter life span, pain, anemia, serious infections and neurocognitive decline. Tract-Specific Analysis (TSA) is a statistical method to evaluate white matter alterations due to neurocognitive diseases, using diffusion tensor magnetic resonance images. Here, for the first time, TSA is used to compare 11 major brain white matter (WM) tracts between SCD patients and age-matched healthy subjects. Alterations are found in the corpus callosum (CC), the cortico-spinal tract (CST), inferior fronto-occipital fasciculus (IFO), inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF), and uncinated fasciculus (UNC). Based on previous studies on the neurocognitive functions of these tracts, the significant areas found in this paper might be related to several cognitive impairments and depression, both of which are observed in SCD patients.
Collapse
Affiliation(s)
- Yaqiong Chai
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Division of Cardiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Julie Coloigner
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| | - Xiaoping Qu
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Soyoung Choi
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| | - Adam Bush
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA
| | - Matt Borzage
- Department of Neonatology, Children's Hospital Los Angeles, CA, USA
| | - Chau Vu
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| | - Natasha Lepore
- CIBORG laboratory, Department of Radiology, Children's Hospital Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, CA, USA.,Department of Radiology, University of Southern California, CA, USA
| | - John Wood
- Division of Cardiology, Children's Hospital Los Angeles, CA, USA
| |
Collapse
|
26
|
Kawadler JM, Kirkham FJ, Clayden JD, Hollocks MJ, Seymour EL, Edey R, Telfer P, Robins A, Wilkey O, Barker S, Cox TC, Clark CA. White Matter Damage Relates to Oxygen Saturation in Children With Sickle Cell Anemia Without Silent Cerebral Infarcts. Stroke 2015; 46:1793-9. [DOI: 10.1161/strokeaha.115.008721] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Sickle cell anemia is associated with compromised oxygen-carrying capability of hemoglobin and a high incidence of overt and silent stroke. However, in children with no evidence of cerebral infarction, there are changes in brain morphometry relative to healthy controls, which may be related to chronic anemia and oxygen desaturation.
Methods—
A whole-brain tract-based spatial statistics analysis was carried out in 25 children with sickle cell anemia with no evidence of abnormality on T2-weighted magnetic resonance imaging (13 male, age range: 8–18 years) and 14 age- and race-matched controls (7 male, age range: 10–19 years) to determine the extent of white matter injury. The hypotheses that white matter damage is related to daytime peripheral oxygen saturation and steady-state hemoglobin were tested.
Results—
Fractional anisotropy was found to be significantly lower in patients in the subcortical white matter (corticospinal tract and cerebellum), whereas mean diffusivity and radial diffusivity were higher in patients in widespread areas. There was a significant negative relationship between radial diffusivity and oxygen saturation (
P
<0.05) in the anterior corpus callosum and a trend-level negative relationship between radial diffusivity and hemoglobin (
P
<0.1) in the midbody of the corpus callosum.
Conclusions—
These data show widespread white matter abnormalities in a sample of asymptomatic children with sickle cell anemia, and provides for the first time direct evidence of a relationship between brain microstructure and markers of disease severity (eg, peripheral oxygen saturation and steady-state hemoglobin). This study suggests that diffusion tensor imaging metrics may serve as a biomarker for future trials of reducing hypoxic exposure.
Collapse
Affiliation(s)
- Jamie M. Kawadler
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Fenella J. Kirkham
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Jonathan D. Clayden
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Matthew J. Hollocks
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Emma L. Seymour
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Rosanna Edey
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Paul Telfer
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Andrew Robins
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Olu Wilkey
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Simon Barker
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Tim C.S. Cox
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| | - Chris A. Clark
- From the Developmental Imaging and Biophysics Section (J.M.K., J.D.C., C.A.C.), Clinical Neurosciences Section (F.J.K.), and Cognitive Neuroscience and Neuropsychiatry Section (E.L.S., R.E.), UCL Institute of Child Health, London, United Kingdom; Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom (M.J.H.); Department of Paediatric Haematology, Barts and The London Hospital NHS Trust, London, United Kingdom (P.T.); Department of Paediatrics, Whittington Hospital
| |
Collapse
|
27
|
Chen R, Arkuszewski M, Krejza J, Zimmerman RA, Herskovits EH, Melhem ER. A prospective longitudinal brain morphometry study of children with sickle cell disease. AJNR Am J Neuroradiol 2014; 36:403-10. [PMID: 25234033 DOI: 10.3174/ajnr.a4101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Age-related changes in brain morphology are crucial to understanding the neurobiology of sickle cell disease. We hypothesized that the growth trajectories for total GM volume, total WM volume, and regional GM volumes are altered in children with sickle cell disease compared with controls. MATERIALS AND METHODS We analyzed T1-weighted images of the brains of 28 children with sickle cell disease (mean baseline age, 98 months; female/male ratio, 15:13) and 28 healthy age- and sex-matched controls (mean baseline age, 99 months; female/male ratio, 16:12). The total number of MR imaging examinations was 141 (2-4 for each subject with sickle cell disease, 2-3 for each control subject). Total GM volume, total WM volume, and regional GM volumes were measured by using an automated method. We used the multilevel-model-for-change approach to model growth trajectories. RESULTS Total GM volume in subjects with sickle cell disease decreased linearly at a rate of 411 mm(3) per month. For controls, the trajectory of total GM volume was quadratic; we did not observe a significant linear decline. For subjects with sickle cell disease, we found 35 brain structures that demonstrated age-related GM volume reduction. Total WM volume in subjects with sickle cell disease increased at a rate of 452 mm(3) per month, while the trajectory of controls was quadratic. CONCLUSIONS There was a significant age-related decrease in total GM volume in children with sickle cell disease. The GM volume reduction was spatially distributed widely across the brain, primarily in the frontal, parietal, and occipital lobes. Total WM volume in subjects with sickle cell disease increased at a lower rate than for controls.
Collapse
Affiliation(s)
- R Chen
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland Department of Radiology (R.C., R.A.Z.), Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - M Arkuszewski
- Department of Neurology (M.A.), Medical University of Silesia, Katowice, Poland
| | - J Krejza
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland
| | - R A Zimmerman
- Department of Radiology (R.A.Z.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Radiology (R.C., R.A.Z.), Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - E H Herskovits
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland
| | - E R Melhem
- From the Department of Diagnostic Radiology and Nuclear Medicine (R.C., J.K., E.H.H., E.R.M.), University of Maryland, Baltimore, Maryland
| |
Collapse
|
28
|
Wong AM, Wang HS, Schwartz ES, Toh CH, Zimmerman RA, Liu PL, Wu YM, Ng SH, Wang JJ. Cerebral diffusion tensor MR tractography in tuberous sclerosis complex: correlation with neurologic severity and tract-based spatial statistical analysis. AJNR Am J Neuroradiol 2013; 34:1829-35. [PMID: 23578671 DOI: 10.3174/ajnr.a3507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE The neurologic significance of residual cerebral white matter tracts, identified on diffusion tensor tractography, has not been well studied in tuberous sclerosis complex. We aimed to correlate the quantity of reconstructed white matter tracts with the degree of neurologic impairment of subjects with the use of DTI and determined differences in white matter integrity between patients with tuberous sclerosis complex and controls with the use of voxelwise analysis. MATERIALS AND METHODS In this case-control study, 16 patients with tuberous sclerosis complex and 12 control subjects underwent DTI. Major white matter tracts, comprising bilateral PF and CF, were reconstructed and assessed for quantity, represented by NOP and NOF. A neurologic severity score, based on the presence of developmental disability, seizure, autism, and other neuropsychiatric disorders, was calculated for each subject. We then correlated this score with white matter quantity. Voxelwise tract-based spatial statistics was used to determine differences in FA, axial, and radial diffusivity values between the tuberous sclerosis complex group and the control subjects. RESULTS NOP and NOF of CF, bilateral PF, and MWT in the tuberous sclerosis complex group were all significantly lower than those in the control subjects (P < .05). The neurologic severity score was moderately negatively correlated with NOF and NOP regarding CF (r = -.70; r = -.75), bilateral PF (r = -.66; r = -.68), and MWT (r = -.71; r = -.74). Tract-based spatial statistics revealed that patients with tuberous sclerosis complex showed a widespread reduction (P < .05) in FA and axial diffusivity in most cerebral white matter regions. CONCLUSIONS Patients with tuberous sclerosis complex with reduced residual white matter were neurologically more severely affected. Tract-based spatial statistics revealed decreased FA and axial diffusivity of the cerebral white matter in the tuberous sclerosis complex group, suggesting reduced axonal integrity.
Collapse
Affiliation(s)
- A M Wong
- Department of Medical Imaging and Intervention Chang Gung Memorial Hospital and Chang Gung University, Keelung, Linkou, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|